Custom lens replacement surgery, formerly known as refractive lens exchange (RLE), is a type of vision correction surgery that replaces the eye’s natural lens with an clear implantable lens. This artificial lens, known as an intraocular lens (IOL), corrects refractive error in the eye (abnormalities in the size or shape of the eye that can affect sight) and sharpens the eye’s focus. This correction reduces or eliminates the need for single vision glasses, bifocals, progressive lenses, trifocals, contact lenses, and reading glasses.

There are three categories of IOLs commonly used today in St. Louis eye surgery centers for custom lens replacement surgery. Each of these lenses replaces your eye’s natural lens. The kind of IOL you receive will depend on your visual needs and eye health.

  1. Monofocal or fixed-focus IOLs offer clear vision at a single focal point, whether near, mid-range, or far. These lenses excel at vision quality, and will give the sharpest vision possible. Patients often boast about the clarity of their vision with these lenses. Toric versions of this and other IOLs also correct astigmatism.
  2. Multifocal intraocular lenses allow clear vision at many distances, including far, intermediate, and near. Common multifocal IOLs include Johnson & Johnson’s Tecnis Multifocal line, Alcon’s Restor line, and Alcon’s PanOptix trifocal IOL line.
  3. Extended depth of focus, or EDOF IOLs, can provide good distance and intermediate vision. However, these lenses typically do not give the patient ideal near vision for reading without the need for reading glasses.

RLE has helped many patients
attain clear vision without glasses.

Custom lens replacement surgery – also referred to as refractive lens exchange (RLE), dysfunctional lens replacement (DLR), clear lens exchange (CLE), and refractive lensectomy – is a surgical procedure that works best for people with both presbyopia (over-40 vision) and either hyperopia (farsightedness), myopia (nearsightedness), or astigmatism. Because the degree and type of refractive error may affect your own results and surgical risks, not all of our St. Louis patients qualify for refractive lens exchange.

Is RLE surgery in St. Louis permanent?

Once the intraocular lenses are installed and the refractive lens exchange procedure is finished, the changes are long-term. These lenses are created of specialty medical grade acrylic and cannot grow or change like the eye’s natural lens. The lens is designed to be a lifetime solution to the vision problems that were occurring before. Once the lens implantation has taken place, the patient’s vision can improve and become sharper and more focused.

Can you have custom lens replacement after LASIK?

The short answer is yes. A custom lens replacement surgery (refractive lens exchange) procedure is, in one sense, a preventative cataract surgery. A cataract is a clouding of the eye’s natural lens as an individual ages, which makes it difficult to see. Everyone who lives long enough will eventually develop a cataract, causing their vision to blur as their internal lens ages and becomes cloudy. LASIK eye surgery is performed on the cornea, or the eye’s outer lens, and is unrelated to natural cataract formation that comes with age. Those who have had a LASIK procedure will still experience the natural lens changes of the eye that occur with age and will need to have cataract surgery or refractive lens exchange. Therefore, it is very common for our St. Louis LASIK patients to have custom lens replacement surgery many years later to correct the aging changes that all eyes undergo and help preserve the clarity of the patient’s vision.

Refractive lens exchange and cataract surgery are both types of lens implant surgery, however, the reason to have the surgery and the desired outcome for each of these surgeries is quite different. In order to have standard cataract surgery, patients must wait until their vision has declined significantly and is not correctable with glasses or contact lenses. Many patients will find it difficult to drive or perform basic daily functions due to the decline in their vision. The goal is to restore vision while continuing to wear glasses including: single vision glasses, bifocals, progressives, computer glasses, and/or reading glasses to see.


Cataract surgery custom lens replacement surgery / RLE
Do you have to wait? Yes. Patients required to wait until ripe cataracts and cloudy inner lenses impair driving and reading. No. Vision is corrected to reduce or eliminate glasses and contacts once presbyopia sets in, years before cataract development
Age Retirement age, 65+ Younger, ages 45-65
End goal See after surgery using combination of contacts and prescription glasses that are updated yearly by your doctor See after surgery without glasses or contacts
Location Separate hospital operating room (OR), ambulatory surgery center (ASC) In office
Personnel Doctors and staff usually divide time between vision correction surgeries and glaucoma, retina, medical cornea, pediatric, eye cancer, infection, and a variety of eye disease and surgical needs; sometimes cardiac, GI, orthopedics, and other surgeries are performed in the same OR facility with the same staff Doctors and staff focus exclusively on vision correction surgery like LASIK and RLE
Additional requirements before surgery May require preoperative labs and x-rays, visit to primary care doctor, anesthesia evaluation, fasting on day of surgery, change out of clothing into gown Most RLE age patients have no preoperative requirements
During surgery IV placement, cardiac monitoring, oxygen, nursing, and sometimes additional anesthesia personnel Like LASIK – no shots, needles, stitches
How many visits Separate visits on separate days usually required for each eye Both eyes can be corrected in one visit
Cost and payment Medicare and insurance pay for basic medical cataract surgery subject to deductibles, co-pays, and fees for the surgeon, hospital, anesthesia personnel, and separately billed medications; insurance does not cover vision correction surgery component Private pay – the goal of RLE is to be glasses-free, and insurance does not cover this
What it does for cataracts Treats cataracts after formation Prevents cataracts
Brinton Vision Brinton Vision surgeons do not take patients to local area hospitals to perform cataract surgery Brinton Vision is among the top 3 RLE providers in the country, according to iOR partners

Are you ready to take the next step in your vision journey?

Custom lens replacement surgery is also a lens implant surgery, but that’s where the similarities with cataract surgery stop. It is performed to correct nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. Notice that I didn’t say anything about cataracts. Most of our St. Louis refractive lens exchange patients don’t want to wait for further vision loss and cataract formation before having their vision corrected with RLE. With RLE, the goal is for patients to attain clear vision without glasses. Most of our patients have little to no need for glasses, bifocals, or readers of any kind. Talk to your Brinton Vision surgeon about specific expectations for your eyes and circumstances.

Can custom lens replacement surgery be redone?

Patients who have had cataract surgery do not usually qualify for vision correction surgery at Brinton Vision, though there are exceptions. At your Brinton Vision Ocular Analysis your surgeon can determine whether you qualify for vision correction surgery.

If you have hyperopia, myopia, presbyopia or astigmatism and think you might be a candidate for refractive lens exchange (RLE), check out our free 60-second self-test. Call Brinton Vision at 314.375.2020 and set up a Brinton Vision Ocular Analysis today to learn more about refractive surgery, including specific risk and benefit information relative to your own eyes.

Learn more: How Much Does Custom Lens Replacement Cost?

Dr. Jason P. Brinton is an internationally recognized specialist in the field of LASIK and refractive surgery. He is a graduate of Harvard College, earned his medical doctorate from the Harvard Medical School and is board certified by the American Board of Ophthalmology.